CMS finalizes risk adjustment rule for benefit year 2018

The Centers for Medicare & Medicaid Services (CMS) finalized its risk adjustment rule for the 2018 benefit year on Friday, its latest step in a string of legal battles dating back to earlier this year.

The rule calculates the payment amounts using the average premium within a state, rather than the premium for each plan. CMS justified this approach by assuming the program must be budget-neutral based on certain provisions in the Affordable Care Act.

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